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2021 07 21

Rūta Pumputienė. Individualized treatment in Lithuania: will the Government's program turn into real, concrete actions?

One of the areas identified by the current government as in need of improvement to ensure patient well-being is individualized treatment. In its program, the government emphasized that it would seek to improve the quality of personal health care services by applying the latest treatment technologies, ensuring the most effective, modern, pathologically appropriate, individualized treatment, not the cheapest one. It was even announced at the beginning of June that with the permission of the Parliament it would be possible to choose not only the cheapest, as required now, but also more expensive reimbursable medicine - unfortunately, this step does not mean that doctors will be better able to take into account the patient's individual situation. In reality, there are still more declarative promises than concrete actions.
Rūta Pumputienė
Rūta Pumputienė / Asmeninio archyvo nuotr.

Naturally, it is the duty of doctors to prescribe medication that is focused on the best treatment outcomes for the individual patient. Indeed, personalized medicine can change the lives of patients by providing personalized healthcare, thus helping to prevent, diagnosing, and treating diseases more effectively and quickly. However, today's situation is worrisome - although the new government's program and the plans already presented offer hope for individualized treatment, the right of Lithuanian patients to quality treatment, and the obligation of Lithuanian doctors to provide the most appropriate treatment to patients according to clinical criteria are still only declarative and, it seems, remain so in the near future.

We have to admit, that access to the most up to date, effective medical treatment is probably the worst and most delayed in Lithuania compared to the European Union, and this situation will not change until the promising provisions of the Government program turn into at least one concrete action that can be implemented in reality. For example, one of the ways to begin is the full integration of international diagnostic and treatment standards into Lithuanian clinical practice. This is necessary to ensure the essential principle of doctors' work - to provide the patient with the necessary, most effective, and safest treatment, taking into account the patient's disease and clinical criteria. In other words, this action would ensure the doctor's duty to provide quality treatment on the basis of scientific evidence and not on the basis of political, economic, or other criteria that have nothing to do with science-based evidence.

Admittedly, at the beginning of June, it was announced that one of the problems that „has been continuing for many years” was solved. For the first time, Seimas allowed to choose not only the cheapest, as required now, but also the more expensive reimbursable medicine, paying only the due surcharge. However, this does not mean that medical personnel will be better able to take into account the individual situation of the patient. Why? Because this change has not been made for all reimbursable medicines but only depends on whether the medicine has a generic analog or not. In the absence of generic analogs, unfortunately, individualized treatment remained essentially impossible for certain diseases (immunological diseases, dialysis patients), even though it is clear that regulation must be non-discriminatory in respect of patients' diseases. Patients must have equal rights regardless of which generic or non-generic medicines are reimbursed by the state for the treatment of one disease or another.

This situation, which prevents individualized treatment, is due to the fact that according to the current order of the Minister of Health the doctor has to prescribe the cheapest medicine from a different mechanism of action when starting treatment (although all other medicines in the group are also reimbursed). It means that the doctor is forbidden to choose the most appropriate treatment for the patient on the basis of clinical criteria, as he is obliged to prescribe the treatment only at the lowest cost, regardless of the patient's right to choose the most appropriate and necessary reimbursable medicine.

Understandably, the state has the right to establish control mechanisms for the reimbursement of medicines, but in my opinion, such control of funds can only ensure the well-being of the patient (which our politicians so adamantly proclaim of seeking) if it does not deny the principle of science-based medicine.

I am convinced that the doctor must have the right to prescribe the most appropriate medicine for a particular patient, thus the actions that limit the doctor's ability to provide the patient with adequate, individualized, evidence-based treatment cannot be tolerated further. Nor should the patient's rights to be reimbursed for the reimbursable medicinal product and to receive the latest treatment based on international expert recommendations be limited. Therefore, the situation that exists today must be changed.

Rūta Pumputienė, a lawyer and an expert in life sciences law.

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